INTRODUCTION — For the first time ever, on 3 October, 2002, the World Health Organization (WHO) launched a World Report on Violence and Health, which was a comprehensive review of the problem of violence on a global scale. The report which was three years in the making had contributions from over 160 experts from around the world.
WHO, among others, stated in that report that each year, more than a million lives are lost and many more suffer non-fatal injuries, as a result of various forms of violence and that overall, violence is among the leading causes of death worldwide among people aged 15-44 years. Although precise estimates were difficult to obtain, the report was of the view that the cost of violence translated into billions of US dollars in annual health care expenditures worldwide, and billions more for national economies in terms of days lost from work, law enforcement and lost investment. Additionally, the report drew attention to the cost in grief and pain, which of course, could not be calculated. Even by the close of its first chapter, the report posited that violence is a global public health problem.
It is in that context that I applaud the Association of Psychiatrists in Nigeria (APN) for thinking outside the box and for picking such a seminal issue as Violence in the Niger Delta of Nigeria, which indeed is a public health problem, for its focus at this year’s conference. For were it to be otherwise, and if my medical students days’ reminiscences on the subject remain valid, such a focus would have more readily been applied on issues such as Stress, Schizophrenia, Paranoia, Manic Depressive Psychosis and the likes, which we (medical students) then erroneously described as “mad men’s diseases”. Indeed, although these conditions can, and do manifest in higher numbers in areas where violence has taken some root, as is currently the case in the Niger Delta of Nigeria, it is how the problem of violence affects the matrix of the health of the community that paints the bigger picture.
So, in aligning myself with the stance of the Association and spotlighting on the wider perspective of the problem, I shall commence this lecture by defining violence and making a statement or two on its various types. Next, in order to orientate a reader of this paper or a participant at this conference who may be unfamiliar with the Niger Delta of Nigeria and the antecedents of violence in the region, a few general remarks will be made of the place. Then I shall use the report of a small prospective study which was carried out a few years ago on Chronic Conflict and Health in the Oil Basins of Nigeria, by the Centre for Health and Development (CHD), University of Port Harcourt – a collaborative research outfit between the University of Toronto (Canada) and the University of Port Harcourt (Nigeria), as a preamble to the health implications of violence in the region. Next, I will speak to the matter of revenue accruing to the Federal Government of Nigeria from the sale of petroleum, which comes exclusively from the Niger Delta and show how violence in the area has reduced crude oil production and, as a result, revenue to government. This will serve as the economic implications. I will then tangentially touch on the quality of life of Nigerians and point out that violence in the Niger Delta is making an already bad situation, worse. My conclusion will define a role for the APN in the context of the violence in the Niger Delta. In addition it will solicit for hope in the future of the region.
VIOLENCE AND ITS TYPOLOGIES
In the 2002 World Report on Violence and Health to which reference was made earlier, the WHO defined violence as:
The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.
This definition by WHO associates intentionality with the committing of the act itself, irrespective of the outcome it produces. Excluded from the definition are unintentional incidents – such as most road traffic injuries.
Regarding the various types of violence, these were stated as self-directed violence, including suicide; interpersonal violence, including intimate partner violence; and collective violence, including terrorist acts and wars.
The current violence in the Niger Delta, could be described as Collective Violence since more often than not, it involves a number of persons acting in unison. Such actions manifest as armed robbery, murders, assassinations, the various forms of abduction and kidnappings, destruction of oil pipelines and the blowing up of oil rigs.
THE NIGER DELTA OF NIGERIA
Two large bodies of water – the rivers Niger and Benue constitute dominant features on Nigeria’s topography. Arising from Guinea and Cameroon respectively, the two rivers effectively partition the country at their confluent point in Lokoja into northern, eastern and western regions. They then run as a single source southwards towards the Atlantic Ocean until they arborize close to Onitsha into multiple rivers, creeks, canals, swamps and a huge deltaic drainage basin, the third largest in the world, which is rich in mangrove forest as well as sediments, called the Niger Delta of Nigeria. The drainage basin stretches for about 150miles from north to south and spreads along the Atlantic coast line for about 200miles.
By the nation’s current administrative structure, nine states constitute the Niger Delta: Abia, Akwa Ibom, Bayelsa, Cross River, Delta, Edo, Imo, Ondo and Rivers; the people of these states come from diverse ethinic groups (about 40) and speak different languages and dialects (about 250). The traditional economic activities of the communities consist of trading, farming and fishing.
For over fifty decades now, the Niger Delta, especially the area described as core Niger Delta – Rivers, Bayelsa and Delta States, has been in the limelight, locally and internationally, for two principal reasons which are reflected in this year’s APN’s annual conference:
Crude Oil Production
Crude oil (petroleum) was first discovered in Nigeria by Shell `D Arcy in commercial quantities in 1956, in Oloibiri, present day Bayelsa State, and two years later, in 1958, the first barrel was shipped out for sale in the international market. From this small beginning, the industry has grown, including deep water and off shore drilling, to become the nation’s major commercial business, eclipsing all others, especially agriculture, which hitherto, was the major source of employment and revenue earner for the country. The industry is currently operated by foremost local and international conglomerates like Shell, Mobil, AGIP, Chevron, Texaco, Monipulo, Afren and the Nigerian National Petroleum Corporation (NNPC).
With the current proven crude oil reserves of 36 billion barrels, and with an average production of 2.6 million barrels per day (Mbopd), Nigeria is the largest producer of crude oil in Africa, 6th in OPEC, and 11th largest supplier in the world. Furthermore, with gas reserves of 187 trillion cubic feet (Tcf), which are substantially higher than crude oil reserves, Nigeria has the 10th largest gas reserves in the world and 30% of Africa’s reserve. Nearly all these reserves (oil and gas) are concentrated in and around the Niger Delta, especially the core Niger Delta.
Much of the nation’s petroleum is classified as “light” or “sweet”, meaning the oil is largely free of sulphur and is easy to refine; the country being the largest producer of sweet oil (Bonny light) in the cartel of the Organization of Petroleum Exporting Countries (OPEC). Sadly the bulk of the country’s natural gas is flared off as associated gas which is obtained during oil exploration and it is estimated that the country loses about 18.2 million USD daily from this.
In terms of exportation, the U.S. remains Nigeria’s largest customer for crude oil, accounting for 40% of the country’s total oil exports; Nigeria provides about 10% of overall U.S. oil imports and ranks as the fifth-largest source for U.S. imported oil.
Agitation, Violence and Instability
The point must be made, ab initio, that dissatisfaction and agitation regarding the region’s neglect and underdevelopment which have ballooned into the violence and instability that now characterize the area and threatens the stability of the country, predated the discovery of crude oil in the Niger Delta. Indeed at the pre-independence Constitutional Conference of 1957 in London, the Rivers Chiefs and Peoples while decrying the underdevelopment of their part of the country expressed fears of discrimination and marginalization by the governments of the day.
This led the British colonial government to set up the Willinks Minority Commission of Enquiry to “ascertain the facts about the fears of minorities in any part of Nigeria…” and corroborating these fears, the Commission’s Report, which was published in 1958 stated:
We were impressed by the arguments indicating that the needs of those who lived in the creeks and swamps of the Niger Delta are very different from those of the interior. We agree it is not easy for a Government of a legislature operating from far inland to concern itself or even fully understand the problems of a territory where communications are so difficult, building so expensive and education so scanty…
However, the safeguards that were recommended in the report, including the creation of the backward and underdeveloped Niger Delta region as a special area for speedy development were never implemented.
Then came the discovery and subsequent escalation of crude oil exploitation in the country; fortuitously or otherwise, the discovery was only made in the Niger Delta region. Revenue accruing to the nation from the sale of the commodity galloped in astronomical proportions, dwarfing and almost bringing to a halt, commercial activities in most other sectors.
Unfortunately, due to endemic bad governance and systemic corruption, the bulk of the revenue that accrued from the sale of crude oil was not ploughed into developing the country to any appreciable degree, – its infrastructure, transportation system, communication, the environment, housing, health care, education, its polity and so on, let alone developing the Niger Delta, from where the commodity is obtained.
In order to stem the discontent that simmered as a result of government’s persistent inability to live up to its responsibility of developing the region, several organs were put in place and approaches tried to bridge the gap of infrastructural deficit in the area. These included:
However, on account of lack of political will for their implementation as well as insufficient funding, none of these agencies has made any serious positive impact on the region. Rather, there has been massive spoilage of the land, devastation of its ecosystem and destruction of the culture and traditional way of life of the people by oil exploratory activities.
So, and unfortunately, the festering discontent in the region, which was originally non-violent, moved on to a higher stage of manifestation – that of violence, which sadly has not only consumed communities in the region, but on occasions, acquired notoriety through criminality in which foreigners, Nigerians and even indigenes of the region as well as children and the elderly, some as young as 3 years, others as old as 80 years, have been kidnapped for ransom!!
HEALTH IMPLICATIONS OF VIOLENCE
Findings from the University of Port Harcourt and its teaching hospital.
In 2000, largely through the efforts of Dr. Owens Wiwa (OW), a Nigerian on the staff of the University of Toronto in Canada (UofT), that university and the University of Port Harcourt in Nigeria (Uniport), established a joint centre which was eventually named Centre for Health and Development (CHD). The mandate of the centre is to conduct research and to engage in interventions to enhance individual and social capacity to cope with environmental and health hazards.
The centre identified an epidemiological survey of the health consequences of chronic stress in Ogoniland, a section of the Niger Delta of Nigeria, where communal strife of over 20 years had resulted in the death of some prominent citizens, as a research priority. In preparation for this research, the centre conducted a pilot study in the latter half of 2002, with OW as principal investigator. The study was carried out in one village which was heavily associated with the conflict and its related violence – being beaten up, being raped, being terrorized with offensive weapons, seeing others hurt or killed, extensive loss of property, or loss of body parts; another one, which was relatively spared, served as control.
A random sample of 45 households in the study village and 55 in the control was drawn and with the aid of a table of random numbers, one adult in each household was selected as the study/control participant. Using a structured interview, information was elicited on socio-demographic characteristics, stress factors, social support, health seeking behavior and others.
Four health measures were used as the study’s dependent variables: posttraumatic stress disorder (PTSD), depressive symptoms, somatization symptoms and blood pressure.
After applying various statistical analyses to the information that was obtained, the results showed that the prevalence of PTSD was significantly associated with exposure to chronic conflict and the consumption of alcohol and that the odds of developing PTSD were 20% higher for one living and working in the study village as compared to one living and working in that of the control.
The most prevalent somatic symptoms were headaches, aches and pains in several parts of the body. In addition, there were complains of dizziness, forgetfulness and insomnia. The incidence of these complains and somatic symptoms were higher in the study group than in the control group.
Regarding the blood pressure readings, the mean systolic blood pressure in the study group was significantly higher than that in the control group.
Thus, the pilot survey identified that chronic violence, as is currently the case in the Niger Delta, adversely influences the health of persons living in the affected environment. It gives rise to various forms of stress syndrome, depression as evidenced by somatization, and elevates systolic blood pressure.
Major reasons for admission and requests for psychiatric consultations of patients seen at the Mental Health Department of the UPTH were reviewed over a ten year period (1999-2008) in two groups (1999-2003) and (2004-2008) to see if the escalation of violence in the region as occurred steeply in the past four years has had an impact on these parameters (see Table).
There was a steady increase in psychiatric morbidity; cases of organic psychiatric disorders more than doubled while cases of drug related disorders and schizophrenia increased by over 50%; drug related disorders were mostly seen in adolescents (mean age 15.5 years).
From Literature Review
Review of the literature indicates that other than physical injuries that may also result in loss of body parts, psychiatric consequences of collective violence, the type currently most prevalent in the Niger Delta, tend to be protean, covering a wide range of clinical features. These features include symptoms of paranoia, as well as anxiety, affective and somatoform disorders. These ailments occur commonly from Posttraumatic Stress Events in which patients relive traumatic experiences in nightmares, flashbacks or intrusive thoughts. Patients’ emotions are numbed just as their social interactions become inappropriate.
Psychiatric health implications of violence are therefore many and manifest commonly as PTSDs as well as other anxiety disorders, drug related ailments, schizophrenia, schizophrenia like conditions such as psychosis and depression and other forms of affective disorders.
ECONOMIC IMPLICATIONS
Nigeria has not always depended on the sale of crude oil to serve as the mainstay of its economy. During the country’s period under colonial rule and for sometime thereafter, proceeds obtained from trade, livestock and the export of agricultural as well as forestry products served this purpose, in addition to meeting domestic needs. These products consisted mainly of groundnuts, millet and cotton from the north of the country, cocoa and rubber from the west and palm oil, palm kernel and timber from the east, while several others like rice, beams, and fruits came from virtually all parts of the country. Indeed Nigeria was among the world leaders in the production of some of these goods and staple food items, notably groundnuts, cocoa, rubber and palm oil.
Accordingly, agriculture contributed more than 75% of export earnings before 1970. But by the mid-1990s, agriculture’s share of exports had declined to less than 5% and to reverse this trend, several strategies and projects, including:
were all put in place. Unfortunately, they were largely unsuccessful as by 1970, the petroleum industry had been firmly established, prompting greatly increased export earnings.
So, at the turn of the millennium, oil and gas exports accounted for more than 98% of export earnings and about 83% of federal government revenue thereby giving rise to a mono cultural economy on which all tiers of government depend – it is estimated that federally allocated funds, essentially from crude oil, constitute about 70% of the spending of most state and local governments.
Even as recent as last year (2007), the situation had not changed much as information obtained from the Annual Statistics Bulletin indicated that for that year, the GDP per capita for the country was $1,126; the total value of exports, $61.50billion of which petroleum export alone was $57.90billion (94.146%).
However, revenue accruing to government from crude oil sales has fluctuated immensely over the years as it is affected by several factors – not least the vagaries of the international market and militancy in the Niger Delta. Here, our focus shall be chiefly on the disruption of oil production caused by violent activities in the Niger Delta including the kidnapping of all categories of persons.
An attempt at a catalogue of some aspects of this violent turn of events would include:
It is estimated that Nigeria has lost an average of 300,000 barrels per day in oil production since 1999 to the prevailing state of violence and instability in the Niger Delta. This translates to daily production loss of about US$18 million which converts to US$58.3 billion dollars in nine years. Furthermore, Nigeria spends thousands of dollars on a monthly basis to repair oil equipment that had been sabotaged and also to maintain the security forces in the Niger Delta.
Somehow, the full impact of these destructive activities and production losses were not totally felt by the country as oil prices kept rising in the international market, thus offsetting the loses. The prices peaked at $147.00 per barrel in March 2008. Based on these figures and with its installed capacity for daily production, the Federal Government had prepared a 2009 national budget of expenditure of well over one trillion naira, which was predicated on an oil benchmark sale of $62.0 per barrel. However, oil prices fell once again in the international market to between $70-$80. This has prompted the Federal Government to review the 2009 national budget proposal downwards, this time, based on a bench mark of $45.0. Some state governors have criticized the new bench mark and the 2009 budget proposal that is based on it as, in their view, the budget will provide too little funds for development.
QUALITY OF LIFE IN NIGERIA
On Friday, September 12, 2008, a publication in the Guardian Newspaper quoted Dr. Magnus Kpakol, the country’s National co-coordinator for the National Poverty Eradication Programme (NAPEP), as saying that 70 million Nigerians live below 65 naira (the nation’s currency) a day. This amount, it was observed, is about 48 cents below the $1 dollar mark for the poorest countries around the world.
Furthermore, according to UNDP publications, Nigeria, with a Human Development Index (HDI – a measure of the quality of the people of a nation) of 0.470, occupies the 158th position in the HDI list of 177 countries. Since 1975, Nigeria’s HDI has been consistently lower than the sub- Saharan average. The probability of its citizens surviving beyond the age of 40 years is 39.0%. Twenty nine per cent of its children (0-5years) are underweight and with an under five mortality rate of 190 per 1,000, the country is rated as one of the world’s worst country for child survival. Similarly, its Maternal Mortality ratio of 1000 per 100, 000 live births is among the highest in the world. In global maternal death league tables, Nigeria always finds itself struggling for bottom positions with countries like Eritrea, Somalia, Sierra Leone and Liberia – very poorly endowed countries to which Nigeria should be serving the role of a big brother.
Adult literacy (% of ages 15 and above) rate in the country is 30.9% and only 52% of its citizens have access to improved water supply. Transportation is poorly developed. The railway system virtually does not function, engine powered water transportation is rudimentary and all season motorable roads are very few indeed. Only 36% of the population has access to electricity from the national grid and for these, the supply is epileptic and of poor quality.
With Nigeria’s huge human and natural resources, the nation has no reason to be this poor and with this extent of derelict infrastructure. Tell Magazine of February 18, 2008, quoting sources from Petroleum Inspectorate Division of the NNPC, Central Bank of Nigeria’s Annual Reports and Annual Abstracts of Statistics, stated that Nigeria produced 23.2 billion barrels of crude oil between 1958 and 2006 and that it obtained a total revenue of N 30 trillion or $250billion from the sale of crude oil for the same period. By any account, this is a large sum of money with which the country ought to have been converted into a developed modern state and its people pulled out of the circle of poverty, disease, and hunger as indeed some other states, like Saudi Arabia, in similar situations have been able to do. Unfortunately, this has not happened.
But by forcing oil production down by as much as 25%, and at a time when oil prices are falling, militancy in the Niger Delta is further reducing money accruing to government for development purposes. In the long run, this may make poverty starker in the country especially in the Niger Delta which currently bears the brunt of destitution, impoverishment and poor physical development.
CONLUSION
Let me start my concluding paragraphs by expressing my indebtedness to this great association for finding me worthy to deliver this year’s Guest Lecture, even though, in the strict sense, I am not one of you. On my part, I readily accepted to take the plunge on the conviction that, in the final analysis, be it Women’s Health, or Child Health, or Public Health or even Mental Health, our goals as doctors operating in these man-made compartments, premised as they are, on expediency, are the same – that of enabling the community to attain a state of physical and mental wellbeing and not one that is just based on the absence of disease.
Outside equally important issues like physical injuries, negative effects on children (child soldiers, closure of schools, rape, orphanage, malnutrition), Kidnapping for ransom has probably been the most visible and globally trumpeted form of the violence in the Niger Delta. For those like me, who have had the experience of going through this lurid and horrendous vice, it was a stressor agent of unimaginable proportion – the gruesome fear and uncertainty regarding the eventual outcome of the kidnapping process, coupled with the antics of the kidnappers. How are we all faring? Many, not able to come to terms with the event, have relocated permanently from the region – some to places outside the country, others to supposedly safer parts of the country. Yet others, handicapped by their inability to provide the wherewithal for such a radical decision are sticking it out in the region. What will be the long term effect of such forced migration, such severe trauma, shock and ordeal on the many children and the elderly, some as young as 3 years, others as old as 80, who have had to go through it? Will the children’s personality development not be affected? How will they react to a society that inflicted such an unwarranted damage and pain on their psyche? What final memories of their abode will the elderly be taking away?
At the end of hostilities, many more will come out with even more gory tales of having lost everything (many homes were burnt down), having lost their entire families or various parts of their bodies. Such persons will need help – physically, mentally and otherwise. And the way you deal with the situation will be best determined by you. Do you empower your colleagues in the various health institutions that are already in the Niger Delta, since it is to them that many of the patients will report? – empower them to be able to mount integrated rehabilitation programms, social support and family reunions especially for the youths who are largely the proponents of the violence. Do you establish and so train persons for a new sub specialty to deal with this emerging and enormously complex issue? This is the challenge and role I see for you as members of the APN – one that is begging for an urgency of action.
But then, amidst so much tales of destruction, tragedy and violence, we must end on a forward-looking note even as we draw inspiration from the “Audacity of Hope” which, only recently, played out a lovely symphony that culminated in what is perhaps, one of the most astounding events of our time. I am of course referring to the election of Barack Obama, the first ever African-American to have this honour, as the 44th President of the United States of America – an event which should hold out hope and promise to all men of colour, including the youths in the creeks of the Niger Delta who have taken to violence. That is at the global level.
In this country, the President, Umaru Musa Yar’ Adua has made the resolution of the Niger Delta crisis one of the fundamental aspirations of his administration even as he expects to make the country’s economy to be rated amongst the first 20 in the world by the year 2020. He has created a Ministry of Niger Delta Affairs, although at the time of concluding the writing of this Guest lecture, neither the setting up of the ministry nor the appointment of the Minister in charge, has been effected. Furthermore, a Technical Committee of 45 persons has been set up under the leadership of Mr. Ledum Mitee, an illustrious son of the Niger Delta, to review all previous recommendations and documentations on the region and to advise on workable ways of fast tracking development in the region, including youth empowerment.
Furthermore, THISDAY newspaper of Sunday 16 November, 2008, carried a news item to the effect that Merril Lynch, one of the world’s leading financial management and advisory companies has listed Nigeria, along with Mexico, Philippines, Colombia, Egypt, Oman, Indonesia, Peru, China and Russia as being the ten world’s safest economies! The country was named the least vulnerable economy in the world according to a report, Global Economics which was complied by a team of experts from the company.
This information, coming at a time when many nations are experiencing financial meltdown, portends well for the country and taken along with others in similar vein in the Nigerian burgeoning economic sector (healthy banks, GDP growth of 7.3% in 2008), is probably a pointer to the fact that the country is now on the right course and so stands a good chance of recovering from its myriads of developmental problems, including militancy in its Niger Delta region.
Nor should some of the sterling events at the level of the Niger Delta itself go unrecognized. The audacious and breathtaking judgments of the nation’s judiciary which have produced two of the current governors in the region – Rotimi Amaechi of Rivers State and Adams Oshiomhole of Edo State, strike a poignant note on justice and fair play which are at the foundation of the discontent in the Niger Delta, notwithstanding the infusion of criminality. Youths across the region are being encouraged to lay down their arms and come out for rehabilitation, which should be all embracing – covering their occupation, social reintegration, housing and education. In addition, a Centre for Addiction and Substance Abuse should be established in Port Harcourt.
Rivers State Government has set up a Truth and Reconciliation Commission under the headship of the erudite and distinguished retired Supreme Court Judge, His Lordship Hon. Justice Kayode Esho, CON. The Commission is doing its best to reconcile individuals, groups and communities who had been set on a collision course and path of warfare, not infrequently, by circumstances that are not unconnected with the curse of crude oil in the Niger Delta. Success is being recorded.
I therefore share the prayer and optimism of all men of goodwill that the Niger Delta crisis and its associated violence should and would soon end. When that happens, it will open the vista to a new set of intricate problems, not least, those that will require your very specialized attention and one for which, to my mind, your association should commence preparation now.
I thank you all for your attention.
Violence in the Niger Delta: Health and Econmic Implications For Nigeria and Nigerians. Guest Lecture Delivered at the 2008 ANNUAL CONFERENCE OF THE ASSOCIATION OF PSYCHIATRISTS IN NIGERIA (APN), By NIMI D. BRIGGS. OON, MD, FAS. University of Port Harcourt, Port Harcourt, Nigeria on Wednesday, November 26, 2008
Pro-Chancellor and Chairman of Council, Federal University, Lokoja, Nigeria. February 2016
Member, Court of Governors, College of Medicine, University of Lagos, October 2015 for four years.
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